California Licensed Clinical Appeals RN

Job Summary

California Licensed Clinical Appeals RN is a remote, full-time position responsible for analyzing and evaluating clinical appeals and grievances, working Monday through Friday with alternating Saturdays.

Key Responsibilities

• Review medical records to determine if requested services meet criteria
• Coordinate reviews with the Medical Director and document determinations accurately
• Interpret Plan language and ensure adherence to confidentiality regulations

Required Qualifications

• Active, unrestricted RN license in state of residence
• 2+ years of clinical experience as an RN in an acute, inpatient hospital setting
• Proficiency in Microsoft Office, Word, Outlook, and Internet applications
• Availability for M-F, 8:00-4:30 in their time zone and alternating Saturdays